No office rate
64776 reports the primary digital nerve neuroma excision. Use 64778 only for an additional digital nerve treated in the same operative session.
On this page
CMS RVU26D · Effective 2026-10-01
64778 Digital neuroma excision Medicare reimbursement rates in Wyoming
Reports excision of a neuroma from an additional digital nerve in the hand or foot during the same session as the primary nerve procedure. Compare 64778 office and facility rates across CMS payment localities in Wyoming.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 64778 in Wyoming?
Wyoming has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$149.42
1 of 1 localities have a supported rate.
Payment area: Wyoming**
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Peripheral nerve surgery
About 64778: Additional digital nerve neuroma excision
Reports excision of a neuroma from an additional digital nerve in the hand or foot during the same session as the primary nerve procedure.
This add-on represents excision of a neuroma from an additional digital nerve in a finger or toe. A hand, orthopedic, plastic, or podiatric surgeon may perform the work in an operating room when a patient has painful neuromas involving more than one digital nerve, such as after nerve injury or prior surgery. The surgeon identifies and removes the additional affected nerve lesion as part of the operative treatment.
Report 64778 only with the primary digital nerve neuroma excision code, 64776, for an additional nerve treated during the same operative session. The operative note should identify the hand or foot, the distinct digital nerves treated, and the neuroma excised at each site. CMS classifies 64778 as an add-on code: it is billed only with a primary procedure and paid within that procedure’s global period.
CMS billing rules for 64778
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU3.03 · 65%
- Practice expense (office) RVU0.97 · 21%
- Malpractice RVU0.64 · 14%
16
Medicare services in 2024 · #6048 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
64778 compared with similar codes
Office rates for Wyoming, from the same CMS release.
No office rate
64774 applies to a neuroma of a cutaneous nerve. Choose 64778 when the additional neuroma excised is on a digital nerve in the hand or foot.
No office rate
64783 is an add-on for additional limb nerve neuroma excision outside the digital-nerve use of 64778.
Compare 64778 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Wyoming** →
Office / nonfacility
Unavailable
Facility
$149.42
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 64778 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
7,231
- Code
- 64778
- Physician work
- 3.03
- Practice expense
- 0.97
- Malpractice
- 0.64
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.03 | × 1.000 | 3.0300 |
| Practice expense | 0.97 | × 1.000 | 0.9700 |
| Malpractice | 0.64 | × 0.740 | 0.4736 |
| Total RVUs | 4.4736 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$149.42
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.03 | 1 |
| Practice expense | 0.97 | 1 |
| Malpractice | 0.64 | 0.74 |
(3.03 × 1 + 0.97 × 1 + 0.64 × 0.74) × $33.4009 = $149.42
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
64778 billing questions
When should 64778 be reported instead of 64776?
Use 64776 for the primary digital nerve neuroma excision. Report 64778 for each additional digital nerve neuroma excised in the same session.
Can 64778 be billed by itself?
No. It is an add-on code and must be reported with the primary digital nerve procedure, 64776.
What should the operative note document?
Document the treated hand or foot, identify each distinct digital nerve, and describe the neuroma excised from the additional nerve.
How many units should be reported?
Report the add-on for each additional digital nerve neuroma excised beyond the primary nerve treated under 64776. The record should support each separately treated nerve.
How does the global period affect 64778?
CMS pays this add-on within the global period of its primary procedure. It is not reported as a standalone service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
7,22864772,,Incision of spinal nerve,A,,7.64,6.39,NA,6.39,,1.43,15.46,15.46,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,22964774,,Remove skin nerve lesion,A,,5.66,5.48,NA,5.48,,1.19,12.33,12.33,0,090,0.11,0.76,0.13,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,23064776,,Remove digit nerve lesion,A,,5.46,4.84,NA,4.84,,0.91,11.21,11.21,0,090,0.11,0.76,0.13,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,23164778,,Digit nerve surgery add-on,A,,3.03,0.97,NA,0.97,,0.64,4.64,4.64,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,23264782,,Remove limb nerve lesion,A,,6.69,5.31,NA,5.31,,1.06,13.06,13.06,0,090,0.11,0.76,0.13,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,23364783,,Limb nerve surgery add-on,A,,3.62,1.15,NA,1.15,,0.78,5.55,5.55,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,23464784,,Remove nerve lesion,A,,10.35,7.72,NA,7.72,,2.08,20.15,20.15,0,090,0.11,0.76,0.13,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,